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Brief report
Cross-cultural adaptation and validation into Spanish of the deprescription questionnaire in the elderly patient
Adaptación transcultural y validación al español del cuestionario de desprescripción en el paciente de edad avanzada
Marta Mejías-Truebaa, Aitana Rodríguez-Pereza,
Corresponding author
aitanarp@gmail.com

Corresponding author.
, Bosco Barón-Francob, Carlos Hernández-Quilesb, Bernardo Santos-Ramosa, Susana Sánchez-Fidalgoc
a Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Unidad de Gestión Clínica Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain
c Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Polypharmacy&#44; understood as the consumption of &#8805;5 or &#8805;10 drugs&#44; is common among elderly patients<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and occasionally accompanied by a potentially inadequate prescription of medications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the main strategies used to reduce polypharmacy and its associated complications is deprescription&#46; This process consists in a review of drugs that&#44; despite being appropriately prescribed&#44; offer an unfavorable benefit-risk ratio due to the patient&#39;s current clinical condition&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Implementation of deprescription is limited by several barriers linked to the process that have already been described in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A questionnaire created with the aim of determining the perceptions of clinicians in relation to deprescription in the elderly population stands out among all tools available to assess these difficulties&#46; However&#44; the original Italian version was never published&#44; and it is currently only available in English&#46; A study using this English version revealed that most clinicians were confident in their ability to deprescribe medications&#44; although certain barriers&#44; such as a lack of time or reluctance to discontinue drugs prescribed by other practitioners&#44; were reported&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to cross-culturally adapt&#44; translate&#44; and validate a Spanish version of the deprescription in the elderly patient questionnaire&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The main author of this questionnaire authorized its cross-cultural adaptation&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The back-translation process was carried out following the methodology proposed by Sousa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and the guidelines of the World Health Organization &#40;WHO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In addition&#44; we consulted other similar works in which back-translation had also been performed&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This allowed us to ensure semantic and non-literal equivalence between both versions and to perform a cultural adaptation to Spanish &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Forward and back-translation</span><p id="par0035" class="elsevierStylePara elsevierViewall">In this first stage&#44; a translator &#40;healthcare professional&#41;&#44; whose mother tongue was Spanish&#44; but who was fluent in both the language and culture of the original questionnaire &#40;Italian&#41;&#44; carried out the forward translation of the questionnaire&#46; Then&#44; a second translator&#44; who did not know the original questionnaire in order to avoid potential biases&#44; performed a back-translation&#46; The mother tongue of this second participant was Italian&#44; although they boasted absolute mastery of the Spanish language and culture&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In addition&#44; each translator used a Likert-type scale scored from 1 to 5 &#40;from least to most difficult&#41; to subjectively rate the complexity of translating each question&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Synthesis and adaptation</span><p id="par0045" class="elsevierStylePara elsevierViewall">Upon receiving the back-translation of the questionnaire&#44; both versions were sent to a third person&#44; a linguist and professional translator&#44; whose mother tongue was Italian&#44; but who was also fluent in the Spanish language and culture&#46; This person&#8217;s task was to review both translations to resolve potential mismatches&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Likewise&#44; based on the scores provided during the previous phase&#44; this linguist classified the difficulty of translating each question as low &#40;1&#8211;2 points&#41;&#44; moderate &#40;3&#8211;4 points&#41;&#44; or high &#40;5 points&#41;&#46; The mean scores for each questionnaire item were calculated&#44; and a new back-translation of those considered to entail a high degree of difficulty was performed&#46; In addition&#44; the correlation between the scores provided by each translator was calculated using Pearson&#39;s linear correlation coefficient to analyze the degree of agreement between them&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Expert panel</span><p id="par0055" class="elsevierStylePara elsevierViewall">A panel of ten experts &#40;internal medicine specialists and hospital pharmacists&#41; was formed&#44; and each panelist was asked to rate each question from 1 to 9 based on the following three variables&#58; adequacy of the translation&#44; comprehensibility of the translated question&#44; and usefulness of the question at issue&#46; The RAND-UCLA Delphi methodology was used to this end&#44; completing two consensus rounds with the same panelists&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">During the second round&#44; the panelists were asked to score questions marked as &#8220;unclear&#8221; or &#8220;undetermined&#8221; &#40;Appendix <a class="elsevierStyleCrossRef" href="#sec0055">B</a>&#44; Annex <span class="elsevierStyleSmallCaps">I</span> of the Supplementary Material&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Comprehensibility analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The last step of the process consisted in analyzing the comprehensibility of the back-translated questionnaire&#46; For this purpose&#44; the survey was shared with a sample of physicians who were familiar with this activity&#46; These participants were requested to answer each item of the questionnaire and&#44; in those cases in which they failed to understand a question&#44; they could suggest alternative expressions&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">During the first phase of translation and back-translation&#44; the mean degree of difficulty of these tasks was rated at&#58; 1&#8239;&#177;&#8239;0 for the title &#40;low difficulty&#41;&#44; 3&#8239;&#177;&#8239;0 for the Introduction &#40;moderate difficulty&#41;&#44; 2&#46;17&#8239;&#177;&#8239;0&#46;24 for the nine questions &#40;low-moderate difficulty&#41;&#44; and 2&#8239;&#177;&#8239;0 for the final subsections &#40;low difficulty&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The difficulty of the foward translation of the nine questions was considered to be low in 66&#46;67&#37; of the cases and moderate in the remaining 33&#46;33&#37;&#46; In the case of the back-translation&#44; the difficulty of translating these questions was deemed low in 88&#46;89&#37; of the cases and moderate in the remaining 11&#46;11&#37;&#46; The calculation of Pearson&#39;s correlation coefficient revealed a statistically significant correlation &#40;<span class="elsevierStyleItalic">r</span>&#8239;&#61;&#8239;0&#46;890&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05&#41; between the scores assigned by both translators&#46; Therefore&#44; it could be concluded that there was concordance between both&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The following changes were made during the back-translation process&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Throughout the questionnaire&#44; terms &#8220;<span class="elsevierStyleItalic">paziente anziano&#8221;</span> and &#8220;<span class="elsevierStyleItalic">pazienti anziani&#8221;</span> were translated as &#8220;<span class="elsevierStyleItalic">paciente&#47;s de edad avanzada</span>&#8221; &#40;elderly patient&#91;s&#93;&#41;&#44; as this is the most commonly used term in our current healthcare setting to refer to this subgroup of patients&#46; However&#44; in certain cases&#44; collocation &#8220;<span class="elsevierStyleItalic">de edad avanzada</span>&#8221; &#40;elderly&#41; was omitted to avoid its repetitive use&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Word &#8220;<span class="elsevierStyleItalic">cesare&#47;cessazione&#8221;</span>&#44; which appears for the first time in the Introduction section&#44; was translated as &#8220;<span class="elsevierStyleItalic">suspensi&#243;n</span>&#8221; &#40;discontinuation&#41;&#44; although it could have also been translated to &#8220;<span class="elsevierStyleItalic">retirada</span>&#8221; &#40;withdrawal&#41;&#44; since both words are used interchangeably as synonyms for deprescription in Spanish&#46; For consistency purposes&#44; this translation of the term was maintained in the rest of the questionnaire&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">In question 3&#44; after analyzing expression &#8220;<span class="elsevierStyleItalic">linee guida</span>&#8221;&#44; it was jointly agreed that it be translated to &#8220;<span class="elsevierStyleItalic">gu&#237;as de pr&#225;ctica cl&#237;nica</span>&#8221; &#40;clinical practice guidelines&#41;&#44; as this term falls more in line with the terminology used in Spanish&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">In question 6&#44; the Italian version used the Anglo-Saxon term caregiver&#44; which was translated as &#8220;<span class="elsevierStyleItalic">cuidador&#47;a&#8221;</span> &#40;caregiver&#41; in Spanish to favor the use of inclusive language&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">The translation of terms &#8220;<span class="elsevierStyleItalic">l</span>&#8217;<span class="elsevierStyleItalic">assunzione&#8221;</span> and <span class="elsevierStyleItalic">&#8220;assumere&#8221;</span> in question 7 involved some difficulties&#46; Even though it has certain connotations referring to oral medication&#44; the use of verb &#8220;<span class="elsevierStyleItalic">tomar</span>&#8221; &#40;to take&#41; was considered preferable&#44; as using term &#8220;<span class="elsevierStyleItalic">consumir</span>&#8221; &#40;consume&#41; was deemed inappropriate&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0110" class="elsevierStylePara elsevierViewall">The results of the first and second round of the panel discussion are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">Finally&#44; all the suggestions made by the panelists were analyzed &#40;Appendix <a class="elsevierStyleCrossRef" href="#sec0055">B</a>&#44; Annex <span class="elsevierStyleSmallCaps">II</span> of the Supplementary Material&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Thus&#44; following the above steps and all changes made to the questionnaire&#44; its final back-translated version is that shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The questionnaire&#8217;s validation was achieved through surveys sent out to a total of 60 physicians&#46; Sixty-five percent of the respondents were female&#44; and the mean age of the participants was 53&#46;5&#8239;&#177;&#8239;12&#46;5 years&#46; The vast majority of these participants were primary care physicians &#40;90&#37;&#41;&#44; and the rest were internal medicine physicians&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">This study&#44; including the back-translation of the questionnaire and its subsequent validation&#44; has generated a tool in Spanish that will allow for determining and analyzing clinicians&#8217; perception of an activity that is becoming increasingly relevant in clinical practice&#44; i&#46;e&#46;&#44; deprescription&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">To obtain this back-translated version&#44; both grammar and terminology changes were made during the first phase of this process to produce expressions that were better adapted to the Spanish language&#44; ableit without affecting the original content&#46; However&#44; following the expert panel discussion&#44; we determined that certain specifications should be included or some expressions modified&#44; as the wording of some questions could contravene the principle of patient autonomy and shared decision-making&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Although the recommendations provided by guidelines and prior studies were followed&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a> because this is a simple questionnaire&#44; we simplified the translation and syntehsis phases&#46; Nevertheless&#44; all required stages were carried out to ensure a high quality&#46; Furthermore&#44; both the comprehensibility analysis and validation were performed by a multidisciplinary expert panel&#44; formed by clinicians from different healthcare centers&#44; and following the RAND-UCLA method&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> which ensured the translation&#8217;s conceptual and semantic equivalence&#44; as well as an excellent comprehensibility of the questionnaire&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">As a limitation&#44; we must mention the fact that the entire process was completed in a standard Spanish language context&#44; which means that the validity of the questionnaire might be compromised in regions with a prevalence of dialects or pronounced variants of the Spanish language&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Finally&#44; we believe that it is noteworthy that this work was the first to produce a cross-cultural adaptation of this questionnaire for our setting and that it has enabled access to a tool to assess clinicians&#8217; perception regarding deprescription and to establish improvements in the approach to this practice&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors of this paper declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In 2017&#44; a questionnaire was developed in Italian with the aim of determining clinicians&#39; perceptions of deprescription in the elderly population&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The objective was to translate and cross-culturally adapt this deprescription questionnaire to Spanish&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Forward and blind-back translations&#44; followed by a synthesis and adaptation by a third translator&#46; Development of an expert panel to evaluate the adequacy of the translation&#44; the understandability of the translated question and the usefulness of each question&#46; A comprehensibility analysis was carried out on physicians familiar with deprescription&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The Spanish version of the questionnaire was obtained&#44; where the average degree of difficulty in the direct and the back-translation was low&#47;moderate&#46; In the first phase of the panel of experts&#44; 4 questions had sections considered &#8220;indeterminate&#8221; and one question was &#8220;doubtful&#8221;&#46; After the second phase&#44; all the questions were considered &#8220;adequate&#8221; except for one&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">This is the first cross-cultural adaptation to Spanish of this questionnaire&#44; which will provide a tool to assess clinicians&#39; perception of this practice and establish improvements to carry out this activity&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">En 2017 se desarroll&#243; un cuestionario en italiano que ten&#237;a como objetivo determinar las percepciones de los cl&#237;nicos ante la desprescripci&#243;n en poblaci&#243;n de edad avanzada&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El objetivo fue traducir y adaptar transculturalmente al espa&#241;ol este cuestionario de desprescripci&#243;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Traducci&#243;n directa y retrotraducci&#243;n&#44; seguidas de una s&#237;ntesis y adaptaci&#243;n por un tercer traductor&#46; Desarrollo de un panel de expertos para evaluar la adecuaci&#243;n de la traducci&#243;n&#44; comprensibilidad de la pregunta traducida y utilidad de cada cuesti&#243;n&#46; Se realiz&#243; un an&#225;lisis de comprensibilidad a m&#233;dicos familiarizados con la desprescripci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se obtuvo la versi&#243;n espa&#241;ola del cuestionario&#44; donde el grado de dificultad medio en la traducci&#243;n directa e inversa fue baja&#47;moderada&#46; En la primera fase del panel de expertos&#44; 4 preguntas tuvieron apartados considerados &#8220;indeterminados&#8221; y una fue &#8220;dudosa&#8221;&#46; Tras la segunda fase&#44; todas las cuestiones fueron &#8220;adecuadas&#8221; a excepci&#243;n de una&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se trata de la primera adaptaci&#243;n transcultural al espa&#241;ol de este cuestionario&#44; lo que permitir&#225; disponer de una herramienta para valorar la percepci&#243;n de los cl&#237;nicos y establecer mejoras en la realizaci&#243;n de esta pr&#225;ctica&#46;</p></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Introduction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unclear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unclear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subsection 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subsection 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
            1 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Second round of panel discussion</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Questionnaire&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adequacy degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comprehensibility degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Usefulness degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adequate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Question 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Unclear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Undetermined&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Summary of the scores assigned to the three variables assessed during the first and second rounds of the expert panel discussion&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Deprescription refers to the systematic process leading to the dose reduction and&#47;or discontinuation of medications that may be harmful to the patient&#44; are no longer benefitial for them&#44; or should be considered inappropriate in the context of the patient&#8217;s care preferences and goals &#40;Scott IA et al&#46;&#44; JAMA&#46; 2015&#41;&#46; The purpose of this brief questionnaire is to anonymously collect information about physician&#8217;s perceptions on deprescription&#46; Please answer all questions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">For each of the following items&#44; mark&#44; with a cross sign&#44; your level of agreement on the graduated scale from 1 to 7&#44; where&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="1" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">1&#58; completely disagree and 2 3 4 5 6 7&#8239;&#61;&#8239;completely agree&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46; From a clinical standpoint&#44; based on my professional experience&#44; I feel prepared to address deprescription in elderly patients&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2&#46; I am in favor or deprescribing medications as a preventive action in elderly patients when their life expectancy no longer justifies the potential benefits&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">3&#46; In the elderly patient&#44; with a limited life expectancy&#44; it might be appropriate to consider deprescribing some medications with therapeutic activity&#44; even if they are recommended by clinical practice guidelines&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">4&#46; In elderly patients&#44; I find it difficult to consider deprescription it there is no solid evidence to continue or discontinue drugs for preventive purposes&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">5&#46; I have no objection to deprescribing medications in elderly patients when they were initially prescribed by another health care professional&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">6&#46; Although I consider that deprescribing medications is important&#44; I cannot devote the necessary time to the patient or their caregiver to perform it properly&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">7&#46; I have no problem with deprescribing medications&#44; and would suggest it&#44; even when the ptaient and&#47;or their caregiver believed that it would be appropriate to continue taking them&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">8&#46; Although the deprescription of medications in elderly patients may be considered appropriate in certain situations&#44; I do not do so for fear of the potential side effects associated with the withdrawal&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">9&#46; I have no difficulty in reaching a consensus on medication deprescription strategies with my patients and&#47;or their caregivers&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Subsection&#58; Demographic characteristics &#40;please answer all questions&#41;&#58;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Age &#40;in full years&#41; &#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95; Sex M F&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Specialization &#40;if applicable&#41;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Back-translation of the deprescription in the elderly patient questionnaire &#40;<span class="elsevierStyleItalic">translated into English in the present file</span>&#41;&#46;</p>"
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                      "titulo" => "The rising tide of polypharmacy and drug-drug interactions&#58; population database analysis 1995&#8211;2010"
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                          "autores" => array:4 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25889849"
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                      "titulo" => "Deprescribing in patients with multimorbidity&#58; a necessary process"
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                            4 => "B&#46; Santos-Ramos"
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                    0 => array:2 [
                      "doi" => "10.1016/j.ejim.2015.06.011"
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                            4 => "K&#46; Fern&#225;ndez-Otaolead"
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                      "doi" => "10.1016/j.jhqr.2019.11.001"
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                        "tituloSerie" => "J Healthc Qual Res&#46;"
                        "fecha" => "2020"
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                      "titulo" => "Barriers to appropriate prescribing in older adults with multimorbidity&#58; a modified Delphi study"
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                          "autores" => array:6 [
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                            3 => "K&#46; Teng-Tan"
                            4 => "W&#46; Ang"
                            5 => "Y&#46; Yoong-Ding"
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                        "tituloSerie" => "Res Social Adm Pharm&#46;"
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                            "web" => "Medline"
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                            "web" => "Medline"
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                      "doi" => "10.1111/j.1365-2753.2010.01434.x"
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                        "tituloSerie" => "J Eval Clin Pract&#46;"
                        "fecha" => "2011"
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                        "paginaInicial" => "268"
                        "paginaFinal" => "274"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20874835"
                            "web" => "Medline"
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                  "referenciaCompleta" => "World Health Organization&#46; Official WHO process of translation and adaptation of research instruments &#91;accessed 22 May 2021&#93;&#46; Available from&#58; <a target="_blank" href="https://www.who.int/substanceabuse/researchtools/translation/en/">https&#58;&#47;&#47;www&#46;who&#46;int&#47;substanceabuse&#47;researchtools&#47;translation&#47;en&#47;</a>&#59; 2016&#46;"
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                      "titulo" => "Cross-cultural adaptation to the Spanish version of the &#8220;Structured HIstory of Medication Use&#8221; questionnaire for medication reconciliation at admission"
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                      "titulo" => "The RAND&#47;UCLA Appropriateness Method User&#8217;s Manual"
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        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0160" class="elsevierStylePara elsevierViewall">We wish to thank Vittorio Maio for allowing us to back-translate the questionnaire and providing us with its original version&#44; Marian Sciarretta and Pierangelo Canton for their collaboration in the cross-cultural adaptation of the questionnaire&#44; and all of the colleagues who participated in our expert panel discussion and enriched the questionnaire with their contributions&#58; Ana Juanes Borrego&#44; Ana Bel&#233;n Guisado Gil&#44; Javier Gonz&#225;lez Bueno&#44; Eva Delgado Silveira&#44; Idoia Beobide Telleria&#44; Bosco Bar&#243;n Franco&#44; Carlos Hern&#225;ndez Qu&#237;lez&#44; M&#225;ximo Bernab&#233;u Wittel&#44; Mar&#237;a Dolores Nieto Mart&#237;n&#44; and Carlos Jim&#233;nez de Juan&#46;</p>"
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Article information
ISSN: 23870206
Original language: English
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